By Kyla Dunn
Caring for the Whole Person
Thirty years ago, psychiatrist Jimmie Holland started a revolution around an idea: Health professionals need to treat the painful emotions associated with cancer, not just the disease
By Kyla Dunn
She was ahead of her time. Until the 1970s, doctors typically informed a family about a cancer diagnosis but hid it from the patient; it was too often a death sentence, bringing hopelessness, stigma and shame. “We couldn’t very well study how people have dealt with cancer when we couldn’t use the word,” Holland notes. By the mid-1970s, however, things had changed. Effective new drugs were improving cancer outcomes, and the patients’ rights movement had produced a new sense that patients deserved to make informed decisions about their own treatment. “To suddenly see people surviving … it was like a miracle,” says Holland. “People began to say, ‘I can survive cancer and I can talk about it.’ ”
In 1977, Holland joined Memorial Sloan-Kettering Cancer Center, in New York City, to start the first full-time psychiatric service in a cancer center. “I felt this was a big opportunity and was a big need,” she says. The service was so pioneering that some oncologists didn’t know how to react. “ ‘Why do we need a psychiatrist? These people are sick,’ ” Holland recalls some of her colleagues asking. “Others said, ‘Wow, you know, it’s about time we looked at these patients’ coping and how to help them better.’ ”
Even the most basic facts about the mental health needs of cancer patients were undefined. How many, for instance, suffered from serious depression or anxiety? (Almost half.) Would antidepressants help them the same way in which they helped physically healthy patients? (Yes.) By talking with patients, Holland began to piece together typical psychological reactions to cancer, and to identify factors that predict good versus poor coping. She was creating the field of psycho-oncology from the ground up.
The need was enormous, she discovered—in part due to people’s tendency to blame the victim: “ ‘It’s your own fault you got the cancer. It must be something you did that brought it on,’ ” is frequently the message, Holland says. “It’s kind of a protective device people use that says, ‘I’m safe; I won’t get it. I’m going to be safer than you are.’ ” Seeking that same sense of control, many people also subscribe to potentially harmful myths about cancer: that a patient’s negative attitudes and emotions can make a tumor grow faster, for example, or that positive thinking will help a patient survive. “There is no scientific basis for these beliefs, which place an unconscionable added burden on patients who already have enough to cope with,” Holland warns in her 2000 book, The Human Side of Cancer, which was co-authored with health journalist Sheldon Lewis. As one distressed patient told her, “If I have to be positive, I’ll never make it. It just isn’t me.”